Tommy Mac 5K

Please understand that this event is rain or shine & non-refundable. Remember this event & its proceeds are for charity. I hereby release the Town of Stratford, the Stratford Professional Firefighters Burn Foudation, HI-TEK Racing, LLC, M.S. Running Productions, Startline Race Services, all personnel involved, volunteers, and co-sponsoring company(ies) from responsibility, from any injuries or damages I may suffer as a result of my participation in the event. I hereby certify that I am in good condition and am able to safely compete in this event. I will additionally permit the use of my name and pictures in print and broadcast, etc. As a participating athlete I certify that the information provided by me in this form is true and complete. The use of anyone's registration bib by a person it was not issued to is NOT PERMITTED and will result in disqualification of both parties AND will VOID all claims against any and all parties as outlined. I have read the entry information provided for this event and certify my compliance by my signature below.


PRINT OUT THIS APPLICATION AND MAIL WITH CHECK

Circle One:   5K ROAD RACE                        

LAST NAME: _____________________________ FIRST NAME: ________________________

SEX:	____________ 	DOB: ____________ AGE ON RACE DAY: __________

ADDRESS:___________________________________________________

CITY: 	_________________________________ STATE: ________ ZIP: _________

TELEPHONE: ___________________________ EMAIL: _____________________________

T SHIRT:  S   M   L   XL             FIREFIGHTER TEAM NAME: _______________________________


SIGNATURE: ____________________________________________
           (parent or guardian must sign if under 18)


Entry Fees: $27.00 By August 18th-  $30 After and on race day
SPECIAL $15.00 FOR THOSE 18 & UNDER! Make check payable to: CFCF Mail to: MSRP 245 Laurel St Stratford, CT 06615

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